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Non-branched microcysts of the pancreas on MR imaging of patients with pancreatic tumors who had pancreatectomy may predict the presence of pancreatic intraepithelial neoplasia (PanIN): a preliminary study

  • Marie-Pierre VulliermeEmail author
  • Lina Menassa
  • Anne Couvelard
  • Vinciane Rebours
  • Frédérique Maire
  • Tony Ibrahim
  • Jerome Cros
  • Philippe Ruszniewski
  • Alain Sauvanet
  • Philippe Levy
  • Philippe Soyer
  • Valerie Vilgrain
Hepatobiliary-Pancreas

Abstract

Purpose

To evaluate whether pancreatic parenchymal abnormalities on magnetic resonance imaging (MRI) are associated with pancreatic intraepithelial neoplasia (PanIN) on histology.

Materials and methods

Retrospective study approved by institutional review board. One hundred patients (48 men, 52 women; mean age, 53.2 ± 16.29 [SD]) underwent MRI before pancreatectomy for pancreatic tumors analyzed by two independent observers blinded to histopathological results for the presence of non-communicating microcysts and pancreatic atrophy (global or focal) beside tumors. MRI findings were compared to histopathological findings of resected specimens. Interobserver agreement was calculated. The association between parenchymal abnormalities and presence of PanIN was assessed by uni- and multivariate analyses.

Results

PanIN was present in 65/100 patients (65%). The presence of microcysts on MRI had a sensitivity of 52.3% (34/65 [95%CI, 51.92–52.70%]), a specificity of 77.1% (27/35 [95%CI, 76.70–77.59]), and accuracy of 61% (61/100 95%CI [50.7–70.6]) for the diagnosis of PanIN while global atrophy had a sensitivity of 24.6% (16/6 [95%CI, 24.28–24.95]) and a specificity of 97.1% (34/35 [95%CI, 96.97–97.32%]). In multivariate analysis, the presence of microcysts (OR, 3.37 [95%CI, 1.3–8.76]) (p = 0.0127) and global atrophy (OR, 9.79 [95%CI, 1.21–79.129]) (p = 0.0324) were identified as independent predictors of the presence of PanIN. The combination of these two findings was observed in 10/65 PanIN patients and not in patients without PanIN (p = 0.013 with an OR of infinity [95%CI, 1.3–infinity]) and was not discriminant for PanIN-3 and lower grade (p = 0.22). Interobserver agreement for the presence of microcysts was excellent (kappa = 0.92), and for the presence of global atrophy, it was good (kappa = 0.73).

Conclusion

The presence of non-communicating microcysts on pre-operative MRI can be a significant predictor of PanIN in patients with pancreatic tumors.

Key Points

• In patients with pancreatic tumors who had partial pancreatectomy, MR non-communicating pancreatic microcysts have a 52.3% sensitivity, a 77.1% specificity, and a 61% accuracy for the presence of PanIN with univariate and with an odds ratio of 3.37 with multivariate analyses.

• The association of global atrophy and non-communicating microcysts increases the predictive risk of PanIN.

Keywords

Carcinoma, pancreatic ductal Magnetic resonance imaging (MRI) Cysts Pancreatectomy 

Abbreviations

BD-IPMN

Branch duct IPMN

IPMN

Intraductal papillary mucinous neoplasm

Microcysts

Pancreas, non-communicating micro cysts

MRCP

MR imaging with MR cholangiopancreatography

MRI

Magnetic resonance imaging

NET

Neuroendocrine tumors

P-NET

Pancreas NET

Pancreatic carcinoma

Pancreatic ductal carcinoma

PanIN

Pancreatic intraepithelial neoplasia

SPPT

Solid and pseudo papillary tumors

Notes

Acknowledgments

We would like to thank Dale Roche who performed the language editing of this paper.

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Marie-Pierre Vullierme MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Tony Ibrahim and Pr Vinciane Rebours kindly provided statistical advice for this manuscript.

Both authors have significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because the study was retrospective upon preoperative MRI.

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Marie-Pierre Vullierme
    • 1
    Email author
  • Lina Menassa
    • 2
  • Anne Couvelard
    • 3
  • Vinciane Rebours
    • 4
  • Frédérique Maire
    • 4
  • Tony Ibrahim
    • 5
  • Jerome Cros
    • 3
  • Philippe Ruszniewski
    • 4
  • Alain Sauvanet
    • 6
  • Philippe Levy
    • 4
  • Philippe Soyer
    • 7
  • Valerie Vilgrain
    • 1
  1. 1.Paris Diderot UniversitySorbonne Paris Cité, INSERM U1149 CRB3ParisFrance
  2. 2.Imaging DepartmentHotel-Dieu de France HospitalBeirutLebanon
  3. 3.Department of PathologyBeaujon University HospitalClichyFrance
  4. 4.Department of PancreatologyBeaujon University HospitalClichyFrance
  5. 5.Oncology Department, Clinical Research Units, Clinical Biostatistical Research UnitsSaint Joseph UniversityBeirutLebanon
  6. 6.Department of Hepato Pancreato Biliary SurgeryBeaujon University HospitalClichyFrance
  7. 7.Department of RadiologyCochin University HospitalParisFrance

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